DESCRIPTION (Verbatim from the application): Cardiovascular disease accounts for almost half of the reported deaths for patients receiving maintenance dialysis. Because incident dialysis patients often have advanced coronary artery disease that is less amenable to treatment as compared with patients with normal renal function, the greatest impact of therapy will be obtained through invention among patients with renal insufficiency, prior to their development of ESRD and earlier in the development of the coronary artery lesions. This proposal will define the impact of varying degrees of chronic renal insufficiency on five-year survival among patients with significant coronary artery disease. This study will further compare patient survival following treatment for coronary artery disease (medical, percutaneous coronary artery intervention and coronary artery bypass grafting) among patients with mild, moderate, and severe renal insufficiency. After evaluating these clinical outcomes, this proposal will estimate the cumulative five-year medical resource utilization (rehospitalizations and cardiac procedures) and costs for patients with chronic renal insufficiency and significant coronary artery disease to compare costs among major patient subgroups. A retrospective cohort design will be used to take advantage of the Duke Databank for Cardiovascular Diseases (DDCD), a large, comprehensive patient database, maintained by the Duke Clinical Research Institute (DCRI) and its associated hospital and physician administrative databases. This study will examine the cardiovascular outcomes that affect the survival of patients with chronic renal insufficiency and patients receiving chronic dialysis. The results of this study will provide evidence for early intervention among the pre-ESRD population with chronic renal insufficiency to improve maximize the efficacy of coronary revascularization and improve survival.